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J Pediatr Infect Dis 2015; 10(03): 063-067
DOI: 10.1055/s-0036-1579686
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Tuberculosis an Emerging Cause of Immune Thrombocytopenia in Children: Literature Review

Smita Ramachandran
1   Department of Pediatrics, Safdarjung Hospital, New Delhi, India
,
Rani Gera
1   Department of Pediatrics, Safdarjung Hospital, New Delhi, India
› Author Affiliations
Further Information

Publication History

25 October 2015

25 December 2015

Publication Date:
14 March 2016 (online)

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Abstract

Immune thrombocytopenia (ITP) is one of the most common causes of acquired hemorrhagic disorders in children. It is known to occur secondary to various infectious and noninfectious diseases. The most common infections associated with secondary ITP in children are Helicobacter pylori, hepatitis C, HIV, varicella, and cytomegalovirus. Thrombocytopenia in tuberculosis is usually part of a pancytopenia secondary to bone marrow suppression. Immune-mediated isolated thrombocytopenia in tuberculosis is rare, and even fewer cases associated with pulmonary tuberculosis have been reported. We report a case of isolated thrombocytopenia as the initial presenting feature of pulmonary tuberculosis, along with a detailed review of ITP, including its pathophysiology, newer diagnostic tools, and emerging association with tuberculosis.

Keywords

immune thrombocytopenia - tuberculosis - children
 

  • References

  • 1 Cines DB, Liebman H, Stasi R. Pathobiology of secondary immune thrombocytopenia. Semin Hematol 2009; 46 (1) (Suppl. 02) S2-S14
    CrossrefPubMedGoogle Scholar
  • 2 British Committee for Standards in Haematology General Haematology Task Force. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br J Haematol 2003; 120 (4) 574-596
    CrossrefPubMedGoogle Scholar
  • 3 Rodeghiero F, Stasi R, Gernsheimer T , et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 2009; 113 (11) 2386-2393
    CrossrefPubMedGoogle Scholar
  • 4 Cines DB, Blanchette VS. Immune thrombocytopenic purpura. N Engl J Med 2002; 346 (13) 995-1008
    CrossrefPubMedGoogle Scholar
  • 5 Cines DB, McMillan R. Pathogenesis of chronic immune thrombocytopenic purpura. Curr Opin Hematol 2007; 14 (5) 511-514
    CrossrefPubMedGoogle Scholar
  • 6 Olsson B, Andersson PO, Jernås M , et al. T-cell-mediated cytotoxicity toward platelets in chronic idiopathic thrombocytopenic purpura. Nat Med 2003; 9 (9) 1123-1124
    CrossrefPubMedGoogle Scholar
  • 7 Zhang F, Chu X, Wang L , et al. Cell-mediated lysis of autologous platelets in chronic idiopathic thrombocytopenic purpura. Eur J Haematol 2006; 76 (5) 427-431
    CrossrefPubMedGoogle Scholar
  • 8 Bhaskar V, Mahto D, Chandra J. Recent Advances in Immune Thrombocytopenic Purpura in Children. Child India; 2013: 3-8
    Google Scholar
  • 9 Gernsheimer T. Epidemiology and pathophysiology of immune thrombocytopenic purpura. Eur J Haematol Suppl 2008; 69 (69) 3-8
    PubMedGoogle Scholar
  • 10 Kuwana M, Okazaki Y, Kajihara M , et al. Autoantibody to c-Mpl (thrombopoietin receptor) in systemic lupus erythematosus: relationship to thrombocytopenia with megakaryocytic hypoplasia. Arthritis Rheum 2002; 46 (8) 2148-2159
    CrossrefPubMedGoogle Scholar
  • 11 Ziakas PD, Routsias JG, Giannouli S, Tasidou A, Tzioufas AG, Voulgarelis M. Suspects in the tale of lupus-associated thrombocytopenia. Clin Exp Immunol 2006; 145 (1) 71-80
    CrossrefPubMedGoogle Scholar
  • 12 Landgren O, Engels EA, Pfeiffer RM , et al. Autoimmunity and susceptibility to Hodgkin lymphoma: a population-based case-control study in Scandinavia. J Natl Cancer Inst 2006; 98 (18) 1321-1330
    CrossrefPubMedGoogle Scholar
  • 13 Kuhne T, Buchanan G, Zimmerman S , et al. A prospective comparative study of 2540 infants and children with newly diagnosed idiopathic thrombocytopenic purpura (ITP) from the intercontinental childhood ITP study group. J Pediatr 2005; 146: 151-152
    CrossrefPubMedGoogle Scholar
  • 14 Murphy MF, Metcalfe P, Waters AH , et al. Incidence and mechanism of neutropenia and thrombocytopenia in patients with human immunodeficiency virus infection. Br J Haematol 1987; 66 (3) 337-340
    CrossrefPubMedGoogle Scholar
  • 15 Rajan SK, Espina BM, Liebman HA. Hepatitis C virus-related thrombocytopenia: clinical and laboratory characteristics compared with chronic immune thrombocytopenic purpura. Br J Haematol 2005; 129 (6) 818-824
    CrossrefPubMedGoogle Scholar
  • 16 Michel M, Cooper N, Jean C, Frissora C, Bussel JB. Does Helicobater pylori initiate or perpetuate immune thrombocytopenic purpura?. Blood 2004; 103 (3) 890-896
    PubMedGoogle Scholar
  • 17 Kashyap R, Chaudhary VP. Haematological manifestations of tuberculosis. In: Sharma SK, Mohan A, , eds. Tuberculosis. New Delhi, India: Jaypee Brothers Medical Publishers; 2006: 370-379
    Google Scholar
  • 18 Liebman HA, Stasi R. Secondary immune thrombocytopenic purpura. Curr Opin Hematol 2007; 14 (5) 557-573
    CrossrefPubMedGoogle Scholar
  • 19 Stasi R, Sarpatwari A, Segal JB , et al. Effects of eradication of Helicobacter pylori infection in patients with immune thrombocytopenic purpura: a systematic review. Blood 2009; 113 (6) 1231-1240
    CrossrefPubMedGoogle Scholar
  • 20 Altintas A, Ozel A, Okur N , et al. Prevalence and clinical significance of elevated antinuclear antibody test in children and adult patients with idiopathic thrombocytopenic purpura. J Thromb Thrombolysis 2007; 24 (2) 163-168
    CrossrefPubMedGoogle Scholar
  • 21 Stasi R, Stipa E, Masi M , et al. Prevalence and clinical significance of elevated antiphospholipid antibodies in patients with idiopathic thrombocytopenic purpura. Blood 1994; 84 (12) 4203-4208
    PubMedGoogle Scholar
  • 22 Provan D, Stasi R, Newland AC , et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 2010; 115 (2) 168-186
    CrossrefPubMedGoogle Scholar
  • 23 Boots RJ, Roberts AW, McEvoy D. Immune thrombocytopenia complicating pulmonary tuberculosis: case report and investigation of mechanisms. Thorax 1992; 47 (5) 396-397
    CrossrefPubMedGoogle Scholar
  • 24 Bairagya TD, Das SK, Jana PK, Bhattacharya S. Immune thrombocytopenic purpura associated with pulmonary tuberculosis. J Glob Infect Dis 2012; 4 (3) 175-177
    CrossrefPubMedGoogle Scholar
  • 25 al-Majed SA, al-Momen AK, al-Kassimi FA, al-Zeer A, Kambal AM, Baaqil H. Tuberculosis presenting as immune thrombocytopenic purpura. Acta Haematol 1995; 94 (3) 135-138
    CrossrefPubMedGoogle Scholar
  • 26 Tabarsi P, Merza MA, Marjani M. Active pulmonary tuberculosis manifesting with idiopathic thrombocytopenic purpura: a rare presentation. Braz J Infect Dis 2010; 14 (6) 639-640
    CrossrefPubMedGoogle Scholar
  • 27 Cohen YC, Djulbegovic B, Shamai-Lubovitz O, Mozes B. The bleeding risk and natural history of idiopathic thrombocytopenic purpura in patients with persistent low platelet counts. Arch Intern Med 2000; 160 (11) 1630-1638
    CrossrefPubMedGoogle Scholar
  • 28 Arnold DM, Dentali F, Crowther MA , et al. Systematic review: efficacy and safety of rituximab for adults with idiopathic thrombocytopenic purpura. Ann Intern Med 2007; 146 (1) 25-33
    CrossrefPubMedGoogle Scholar
  • 29 Kuter DJ, Bussel JB, Lyons RM , et al. Efficacy of romiplostim in patients with chronic immune thrombocytopenic purpura: a double-blind randomised controlled trial. Lancet 2008; 371 (9610) 395-403
    CrossrefPubMedGoogle Scholar
  • 30 Jurak SS, Aster R, Sawaf H. Immune thrombocytopenia associated with tuberculosis. Clin Pediatr (Phila) 1983; 22 (4) 318-319
    CrossrefPubMedGoogle Scholar
  • 31 Bakhshi S, Kabra M, Iyer VK, Arya LS. Thrombocytopenic purpura as a presenting manifestation of tubercular lymphadenitis. Indian J Pediatr 2003; 70 (12) 993-994
    CrossrefPubMedGoogle Scholar
  • 32 Krishnamurthy S, Yadav S. Immune thrombocytopenic purpura as a presentation of childhood tuberculosis. Indian J Pediatr 2007; 74 (9) 853-855
    CrossrefPubMedGoogle Scholar
  • 33 Singh SP, Misra GC, Prusty PK, Das RK. Tubercular lymphadenitis with purpura. J Indian Med Assoc 1986; 84 (8) 247-249
    PubMedGoogle Scholar
  • 34 Garrido-Colino C, Saavedra-Lozano J. Severe thrombocytopenia in a child secondary to pulmonary tuberculosis. J Pediatr Hematol Oncol 2008; 30 (5) 407-408
    CrossrefPubMedGoogle Scholar
  • 35 Verma S, Narayan K. Miliary tuberculosis with tubercular meningitis with thrombocytopenic purpura. Int J Pulmonar Med 2007; 10 (1)
    PubMedGoogle Scholar
  • 36 Akyildiz B, Uzel N, Yanni D, Citak A, Karaböcüoğlu M, Uçsel R. Immune thrombocytopenic purpura associated with pulmonary tuberculosis. Turk J Pediatr 2009; 51 (3) 271-274
    PubMedGoogle Scholar
  • 37 Borie R, Fieschi C, Oksenhendler E, Galicier L. Tuberculosis associated thrombocytopenic purpura: effectiveness of antituberculous therapy. Hematology Rev 2009; 1: e3
    PubMedGoogle Scholar
  • 38 Srividya G, Nikhila GPS, Kaushik AV, Jayachandran K. Immune thrombocytopenia in tuberculosis: causal or coincidental?. J Glob Infect Dis 2014; 6 (3) 128-131
    CrossrefPubMedGoogle Scholar